The Wall Street Journal recently ran a report on medical care and the sorts of innovations that are being proposed, and in many cases, tried, in the interest of improving care and reducing costs. I recommend most of the articles, as they are very interesting for a variety of reasons. In particular, though, I would like to focus on an article about electronic medical records.

Although it is beyond the scope of this entry, my initial reaction to the article was surprise that the government was the innovator. However, the more I thought about it, the surprise was unwarranted. If I think about programs like DARPA (which most famously gave us the Internet), or NASA (a host of technologies, with the most basic, but most useful being Velcro), then I realize that the government is the source of the some of the best technology improvements we’ve experienced over time. Those innovations may have been very expensive (and probably all were), but they were also revolutionary.

In this case, we know nothing of the cost, but we clearly see the outcome. What was a system that used to require thousands of folders, and countless pieces of paper, became one that was entirely electronic. I would be curious to know the cost savings in paper processing, alone (labor, paper, ink, pens, etc.). However, the focus of the article was on the improvements in care that came from this system. These improvements did not result from mere paperwork reduction, but rather from integration and accessibility.

We see that any doctor, anywhere within the VA system can access his patients records to determine his medical history. Not only can he see what diagnoses and tests have been performed, he can review the actual output of things like x-rays and MRI’s. Access to this information not only prevents the ordering of duplicate tests, but it allows the practitioner to more thoroughly evaluate the patient – even before the patient arrives for care. This accessibility also supports metrics generation, which can, in turn, be used to monitor doctor performance as well as treatment vs. outcome sorts of intelligence gathering.

The other key aspect of the system, is its integration with other systems such as drug interaction databases and home health monitoring. These allow alerts to be provided to the practitioner, not only to prevent mistakes, but also to allow for intervention where it might otherwise not occur. In the example cited in the article, we learn that a patient has an inappropriate glucose level. This problem remains flagged in the system until it is corrected.

What I would really have liked to know is what was the original program charter for this record system? I suspect somehow that the goal (especially back in the 70’s) was largely the reduction of paper. The integration and global accessibility were probably not primary goals of the system. However, I would guess that the majority of the benefit of the system, even on a cost-only basis, derives from these two items. This might well be an example of what I discussed earlier, where the real requirements for the system – the ones that would result in the most value – were not the primary drivers of the system. Unfortunately, there is no way to tell from the article, but I do wonder.